Individual
MRS. LESLIE SAMPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
175 DEEP GAP RD, 175 DEEP GAP RD., JACKSON, TN 38301-9058
(731) 736-0476
Mailing address
175 DEEP GAP RD, 175 DEEP GAP RD., JACKSON, TN 38301-9058
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3487
TN
Other
Enumeration date
02/07/2011
Last updated
02/07/2011
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